腰椎间盘突出症硬膜外阻滞治疗效果与影像学区域定位的相关性  

RELATIONSHIP BETWEEN THE THERAPEUTIC EFFECT OF EPIDURAL BLOCKING IN LUMBAR DISC PROTRUSION AND THREE-DIMENSIONAL LOCALIZATION

作　　者：刘传圣[1] 李淑虹[1] 华震[1] 尹燕伟[1] 王洪友[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,山东青岛266003

出　　处：《青岛大学医学院学报》2004年第3期240-242,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：①目的　通过腰椎间盘突出症的硬膜外阻滞治疗效果与影像学区域定位的相关性分析 ,为硬膜外阻滞治疗腰椎间盘突出症方法的选择和治疗效果预测提供客观参考依据。②方法　将突出的椎间盘在椎管内所处的位置从矢状位、额状位及水平位进行三维定位诊断。矢状位分为Ⅰ、Ⅱ、Ⅲ三个层面 ,水平位分为 1、2、3、4四个区 ,额状位分为a、b、c、d四个域。根据病人的症状、体征及影像学区域定位诊断 ,选择病变间隙 ,用 7号腰穿针硬膜外隙注射消炎镇痛液 ,每周 1次 ,4次为一疗程。一个疗程后评定治疗效果 ,并与其影像学区域定位诊断进行相关性分析。③结果　硬膜外阻滞治疗腰椎间盘突出症的疗效与突出椎间盘在椎管内所处的层面、区及域有明显相关性 (Hc=6 8.2 5～ 4 72 .94 ,q =2 1 .6 3～ 5 0 79.2 5 ,P <0 .0 1 )。Ⅰ层面 1、2区a域突出硬膜外阻滞治疗效果最佳 ,Ⅱ层面 3区、Ⅲ层面 2区突出治疗效果差 ;突出椎间盘达c域以上时硬膜外阻滞无效 ;2个以上椎间盘同时突出时 ,治疗效果降低 ,差异均有显著性 (Hc=1 1 4 .0 2 ,q =1 0 2 .5 2～ 1 92 .2 5 ,P <0 .0 1 )。④结论　腰椎间盘突出症的影像学区域定位诊断可为预测硬膜外阻滞疗效提供重要的。Objective To detect the effect of epidural blocking for lumbar protrusion , and to explore the relationship between the effect and the three dimensional localization. Methods The orientation was made according to patients, symptoms, signs, and radiography. The three dimensional localization was made with CT scan. The mixture of anti inflammatory and analgesic was injected into epidural cavity with a 7 # needle once a week. The results were analyzed with the dimension localization of the prolapsed discs. Results The effect of the blocking was correlated significantly with the level ,zone and area of the prolapsed discs ( H c=68.25-472.94, q=21.63-5 079.25,P <0.01). The discs located in Area a, Zones 1 and 2, LevelⅠ showed the best curative effect. The poor results was demonstrated in those located in Zone 3, Level Ⅱand Zone 2, Level Ⅲ. The difference was significant ( H c=114.02, q=102.52-192.25, P <0.01).No effect was achieved if the lumbar disc extruded to Area c. Conclusion The three dimensional localization of the lumbar discs protrusion provides an important and objective basis for the prediction of the therapeutic efficacy of the disease by using epidural blocking.

关 键 词：椎间盘移位 注射 硬膜外 影像学区域定位 

分 类 号：R681.53[医药卫生—骨科学]